Cranial Computed Tomography Use in Pediatric Head Trauma: Assessing Appropriateness, Insights, and Recommendations in a Single-Centre Cohort

BACKGROUND/OBJECTIVES: Acute head trauma (AHT) is a common reason for pediatric emergency department (ED) visits, although most cases do not result in clinically important traumatic brain injury (ciTBI). Clinical decision rules such as PECARN can help identify children at risk for ciTBI and guide the need for cranial computed tomography (CT). Despite this, CT appears frequently overused, raising ongoing concerns about radiation exposure, resource utilization, and clinical yield. This study evaluated after-hours CT utilization patterns and diagnostic yield for pediatric head trauma at a tertiary care centre. METHODS: We conducted a retrospective review of after-hours non-contrast cranial CT examinations for pediatric (<16 years) head trauma performed between January 2020 and February 2024. Data extracted included presence of skull fracture and/or intracranial injury (ICI; bleed, contusion, or combination), radiation dose, and follow-up imaging. Patients were grouped by age (<2 and ≥2 years). RESULTS: Among 361 children (median age 6 years; 150 females), 267 examinations (74%) were normal, with no evidence of skull fracture (79.8%) or acute ICI (83.9%). Only 29 cases (8%) underwent follow-up imaging. Children <2 years (n = 97) demonstrated higher rates of positive findings: 34% (33/97) had skull fractures and 24.7% (24/97) had ICI. CONCLUSION: In this cohort of after-hours ED-initiated cranial CT examinations, most studies did not demonstrate acute traumatic findings, particularly in children ≥2 years. Imaging of younger children had a comparatively higher diagnostic yield. These findings describe institutional CT utilization patterns and may inform future quality improvement initiatives and local imaging pathways.